Healthcare Provider Details

I. General information

NPI: 1518266972
Provider Name (Legal Business Name): DENTAL CARE IN YOUR HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8104 CEDAR CREEK DR NW
ALBUQUERQUE NM
87120-3844
US

IV. Provider business mailing address

8104 CEDAR CREEK DR NW
ALBUQUERQUE NM
87120-3844
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-0951
  • Fax:
Mailing address:
  • Phone: 505-615-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH227
License Number StateNM

VIII. Authorized Official

Name: MRS. CATHERINE MARY ELLIOTT
Title or Position: PRESIDENT OF THE BOARD OF DIRECTORS
Credential: RDH
Phone: 505-615-0951